Mortality and Practice Patterns in the MEXHEMO Hemodialysis Cohort

Introduction: Chronic kidney disease represents a major public health challenge in Mexico. In the absence of a national hemodialysis (HD) registry, epidemiological data on patient characteristics, treatment practices, and outcomes remain scarce. The MEXHEMO project aims to characterize the clinical profile and outcomes of Mexican patients undergoing chronic HD. Methods: This was a retrospective, observational cohort study. Centers nationwide were invited to report data from patients receiving maintenance HD between January 1 and June 30, 2023. Demographic, clinical, dialysis-related, and laboratory information was collected. Vital status was ascertained from medical records at each dialysis center, with 6 months of follow-up. Outcomes were mortality rates, standardized mortality ratios (SMRs), and risk factors for death. SMRs were calculated using the 2019 United States Renal Data System (USRDS) and the 2024 Chilean HD registry as reference populations. Results: A total of 11,779 patients from 41 clinics were included. Mean age was 52 ± 16 years; 57% were male, and 92% had social security coverage. High-flux HD was prescribed in 86%, and 43% underwent dialyzer reuse. The crude mortality rate was 130 (95% confidence interval [CI]: 121-139) deaths/1000 patient-yrs. SMR were 1.31 (95% CI: 1.25-1.38) compared with the USRDS, and 1.57 (95% CI: 1.52-1.62) compared with the Chilean registry. Lack of social security coverage, hypoalbuminemia, hemoglobin (Hb) ≤ 9 g/dl, catheter use, and dialyzer reuse were independently associated with mortality. Conclusion: MEXHEMO constitutes the largest cohort of HD patients reported in Mexico. The findings highlight elevated mortality despite a relatively young population, emphasizing the need for a national registry and quality improvement policies.